Background: One of the major health issues facing the world today is addiction. It is a rapidly developing health issue in Saudi Arabia. Given how intensely addictive methamphetamine is and how strongly its usage is linked to violent crimes and extremely aggressive conduct, methamphetamine addiction is one of the most hazardous health problems. There has been a concerning rise in the usage of crystal methamphetamine, often known as "Shabu," in the Saudi market in recent years. The aim of this work was to identify the type of aggressive behaviors and psychotic symptoms in patients’ methamphetamine abuse and patients with polysubstance abuse without methamphetamine abuse in Emergency Department, Riyadh Hospitals. Methods: The study was conducted upon 100 drug abuse participants who attended Riyadh Saudi Arabia Emergency Department seeking for treatment of drug dependence. All patients were subjected to drug screening and assessment of delusions, mood disorders and Modified Overt Aggression Scale. Results: Verbal aggression, self-aggression and aggression against others were significantly higher in methamphetamine abusers’ group than other polysubstance abusers group (p<0.05). Methamphetamine addicts exhibited higher rates of restlessness, the need for physical restraint, spouse betrayal of delusion, disorientation, and self-harm than other groups of polysubstance abusers (p<0.05). Conclusion: Methamphetamine abusers displayed significantly higher rates of aggressive behaviors and specific psychotic symptoms compared to other